The physicians used stem cells taken from the fat tissue of the 14-year-old Brad Guilkey who was born with Treacher Collins syndrome. The stem cells were combined with growth protein and donor tissue to grow viable cheek bones in the teen.

Guilkey did not have developed zygomatic bones on either side of his face. The zygomatic bones form the prominence of the cheek and part of the outer rim of the eye socket. These bones are critical structurally and acts as a shock absorber for the face, protecting the eyes and other critical structures in the event of facial impact.

Jesse Taylor, MD, a surgeon and researcher in the Division of Craniofacial and Pediatric Plastic Surgery at Cincinnati Children’s Hospital Medical Center headed the surgical team. He feels that the new procedure will dramatically improves the options surgeons have for repairing bone deficiencies caused by traumatic injuries – such as those from car accidents or soldiers wounded in battle – or by disease and genetic conditions. An estimated 7 million people in the United States have defects in bone continuity so severe that repair is difficult.

Guilkey’s surgery was performed on May 28. During the day-long operation, Dr Taylor and his team used a section of donor bone to craft what essentially were mineral-based scaffolding implants (known as allografts), which also served as a growth guide for the new bone. Surgeons drilled holes in the allografts, which then were filled with mesenchymal stem cells taken from the patient’s abdominal fat. Also injected into the allografts was a growth protein called bone morphogenic protein-2 (BMP-2) that instructs the stem cells to become bone cells called osteoblasts.

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Particularly critical to that process is wrapping the donor allograft bone in a thin membrane of tissue that coats bone surfaces called periosteum. The periosteum used in this surgery was taken from the patient’s thigh. Periosteum is important to the body’s normal production of BMP-2, and just as vital to providing a blood supply to nourish new bone formation.

Dr. Taylor said the procedure has been successful. At more than four months after the surgery, computer tomography (CT) scans show the teenager’s cheek bones have filled in normally with viable bone. The new bone structure enhances his appearance and improves protection for his eyes. Additional touchup surgery to the teenager’s eye lids is under consideration to address a slight downward slant, also characteristic of Treacher Collins syndrome.

Treacher Collins syndrome (TCS) is a rare genetic, craniofacial birth defect that is characterized by a range of distinctive facial anomalies. One of the main features includes underdeveloped or missing cheek bones. Other characteristics of TCS are downward slanting eyes, small lower jaw, and malformed or missing ears. These anomalies can cause hearing, breathing, and eating problems. About one in ten thousand babies are born with it. A person with Treacher Collins syndrome has a 50% chance of passing it onto their children.

As for Brad, now 15, and his mother, Christine, they’re just happy Brad can play sports and participate in other activities without having to worry about a lack of facial bone making him more susceptible to serious eye injury.

“Until we had the CT scans before surgery, we had no idea that Brad was missing the bones that protect his eyes, and that’s very dangerous,” said Christine. “I was nervous about the procedure, but we’re glad we did it and amazed with the results. The people at Cincinnati Children’s do a great job of explaining things to you and we have a lot of trust in the doctors and staff.”